الفهرس 
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Abstract
Introduction With a lifetime risk of 8.6% for males and 6.7% for females, acute appendicitis (AA) is among the most common causes of acute abdominal pain leading patients to the emergency department (1). Traditionally, AA is treated with appendectomy by either an open or a laparoscopic approach. Therefore, appendectomy is one of the most frequent surgical procedures (2). Appendectomy, like any other operation, has potential complications on both short and long-term follow-up including wound infections, ileus, intra-abdominal abscesses, intra-abdominal adhesions and incisional hernia (3). Therefore, a high percentage of pointless negative appendectomies could result in pointless morbidity and even mortality (4). There is a growing interest in the non-operative management (NOM) of uncomplicated AA. Data suggest that antibiotic treatment may be an effective treatment modality for adult patients with AA and that approximately 75% of those patients may not need appendectomy at all, either during initial illness or during the first year of follow-up (5). The immune function of the appendix, which may act as a crucial component of gut immunity, is preserved by NOM, and this is why proponents of this course of therapy support it (6). According to a recent study, the majority of patients presenting with appendicitis in USA undergo laparoscopic appendectomy, and only 6% of those with uncomplicated appendicitis are treated conservatively with antibiotics (7). - 2 - Introduction The lack of high-quality research on the applicability of conservative treatment with antibiotics for uncomplicated AA to the general population in terms of patient-centered outcomes, such as quality of life and overall complication rates, has highly limited the use of this strategy (8). In a survey study on 1728 respondents, 1566 respondents (90.6%) chose appendectomy and 162 (9.4%) chose antibiotics alone (9). Several studies, published in the last decade, support the clinical hypothesis that the presence of an appendicolith is an independent predictor of both perforation and failure of NOM of AA (10,11), therefore, it is strongly recommended to exclude patients with appendicoliths from NOM (12). Other independent predictors of the outcome of NOM varied among few different clinical trials. These included C-reactive protein (CRP) level, white blood cell (WBC) count, age of the patients (13), duration of symptoms prior to admission, body temperature, modified Alvarado score and diameter of the appendix on imaging studies (14).